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The literature advocates surgical treatment with reconstruction to regain ankle push\u2010off strength. The preferred technique is, however, still unknown and is often individualized. This study aims to present the technique and clinical outcome of an endoscopically assisted free semitendinosus reconstruction of chronic Achilles tendon rupture and Achilles tendon re\u2010ruptures with delayed representation. It is hypothesized that the presented technique is a viable and safe alternative for distal Achilles tendon ruptures and ruptures with large tendon gaps.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Twenty\u2010two patients (13\u00a0males and 9 females) with a median (range) age of 64 (34\u201373) treated surgically with endoscopically assisted Achilles tendon reconstruction using a semitendinosus autograft were included. The patients were evaluated at 12\u00a0months post\u2010operatively for Achilles tendon Total Rupture Score (ATRS), calf circumference, Achilles Tendon Resting Angle (ATRA), heel\u2010rise height and repetitions together with tendon length determined by ultrasonography, concentric heel\u2010rise power and heel\u2010rise work.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The patients reported a median (range) ATRS of 76 (45\u201399) out of 100. The median (range) ATRA on the injured side was 60\u00b0 (49\u00b0\u201075\u00b0) compared with 49.5\u00b0 (40\u201361\u00b0), <jats:italic>p\u2009<\/jats:italic>&lt;\u20090.001, on the non\u2010injured side. Eighteen out of 22 patients were able to perform a single\u2010leg heel\u2010rise on the non\u2010injured side. Sixteen patients out of those 18 (89%) were also able to perform a single heel\u2010rise on the injured side. They did, however, perform significantly lower number of repetitions compared with the non\u2010injured side with a median (range) heel\u2010rise repetitions of 11 (2\u201322) compared with 26 (2\u201327), (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), and a median (range) heel\u2010rise height of 5.5\u00a0cm (1.0\u201311.0\u00a0cm) compared with 9.0\u00a0cm (5.0\u201311.5\u00a0cm), (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The median calf circumference was 1.5\u00a0cm smaller on the injured side, 37.5\u00a0cm compared with 39\u00a0cm, when medians were compared. The median (range) tendon length of the injured side was 24.8\u00a0cm (20\u201328.2\u00a0cm) compared with 22\u00a0cm (18.4\u201324.2\u00a0cm), (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), on the non\u2010injured side.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The study shows that endoscopically assisted reconstruction using a semitendinosus graft to treat chronic Achilles tendon ruptures and re\u2010ruptures with delayed representation produces a satisfactory outcome. The technique can restore heel\u2010rise height in patients with more distal ruptures or large tendon defects and is therefore a viable technique for Achilles tendon reconstruction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>IV.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-022-06943-2","type":"journal-article","created":{"date-parts":[[2022,4,9]],"date-time":"2022-04-09T02:02:27Z","timestamp":1649469747000},"page":"2477-2484","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Endoscopically assisted reconstruction of chronic Achilles tendon ruptures and re\u2010ruptures using a semitendinosus autograft is a viable alternative to pre\u2010existing techniques"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9682-1051","authenticated-orcid":false,"given":"Niklas","family":"Nilsson","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg G\u00f6teborgsv\u00e4gen 31, M\u00f6lndal 431 80 Gothenburg Sweden"},{"name":"<!--<label>2<\/label>--> Department of Orthopaedics Sahlgrenska University Hospital M\u00f6lndal Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baldvin","family":"Gunnarsson","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg G\u00f6teborgsv\u00e4gen 31, M\u00f6lndal 431 80 Gothenburg Sweden"},{"name":"<!--<label>2<\/label>--> Department of Orthopaedics Sahlgrenska University Hospital M\u00f6lndal Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Carmont","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg G\u00f6teborgsv\u00e4gen 31, M\u00f6lndal 431 80 Gothenburg Sweden"},{"name":"<!--<label>4<\/label>--> Department of Orthopaedic Surgery Princess Royal Hospital, Shrewsbury and Telford Hospital NHS Trust Shropshire UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annelie","family":"Brorsson","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg G\u00f6teborgsv\u00e4gen 31, M\u00f6lndal 431 80 Gothenburg Sweden"},{"name":"<!--<label>3<\/label>--> IFK Kliniken Rehab Gothenburg 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